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Strategies to Improve Inadequate Bowel Preparation for Colonoscopy


Strategies to Improve Inadequate Bowel Preparation for Colonoscopy

Goretti Hernández et al. Front Med (Lausanne).


Bowel cleansing is one of the most important parameters included in the evaluation of colonoscopy quality. The available evidence suggests that inadequate bowel preparation reduces the diagnostic yield of colorectal neoplasia and increases post-colonoscopy colorectal cancer risk. Nowadays, up to 30% of patients referred for colonoscopy have a poor bowel cleansing. Recently, several studies have analyzed the risk factors for inadequate bowel cleansing as well as the strategies to optimize bowel preparation. In this review, we have focused on summarizing the available evidence in this field.

Keywords: bowel cleansing; improve bowel cleansing; inadequate bowel preparation; quality of colonoscopy; risk factors of bowel cleansing.


Figure 1
Figure 1
Recommendations to improve bowel cleansing in patients with increased risk for inadequate bowel preparation. (1) Sociodemographic features as elderly, male sex, single status, and low educational level are predictive factors for suboptimal bowel preparation. Enhanced education (additional audiovisual material or instructions) improves bowel cleansing quality in these individuals. (2) Patients with low tolerability or acceptance should be offered a different bowel cleansing solution, giving priority to low-volume agents. (3) Patients with a history of suboptimal cleansing, diabetes mellitus, abdominal, or pelvic surgery, chronic constipation, receiving tricyclic antidepressants, or obesity may need a combination of measures to improve to reach an adequate bowel preparation.

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